Wednesday, February 9, 2011

I have a serious question about health care policy

I know I'm going to regret this as soon as someone compares me to Hitler in the comments, but...

I have a question about conservatives and health care that I’ve never been able to get an answer to.

Now, as I understand it, the conservative approach to health care in the US is basically: You’re on your own. If you want health insurance, buy some or get hired by an employer who offers it. If you don’t want health insurance, no problem, just pay for your health care as you go. No government involvement in health care.

So, if we adopt this system, which is more or less what we have now (minus Medicare and Medicaid, of course, but those are only for a limited segment of the population), there will be a certain number of people who choose not to buy health insurance and go around uninsured.

And there will be a certain number of THOSE people who get into motorcycle accidents or get shot or get cancer and have to go to the Emergency Room for treatment, since, if you don’t have health insurance in the US, that’s where you go for primary care.

And there will be a certain percentage of THOSE people who can’t afford to pay for their treatment, and, in fact, will never pay for it. I mean, I know hospitals use collection agencies and everything to get money out of people, but some people you will just never collect from.

So the hospitals pass on the costs of treating those people to the rest of us, in the form of higher medical costs and higher insurance rates and whatever.

So I guess my question is, is that a good system? In the conservative view, do we, as a society, just pay for the deadbeats who show up at the ER with no insurance? And if it would be demonstrably cheaper, for society as a whole, to have some kind of low-cost universal health care, why wouldn’t you want that? I mean, why pay more just to avoid having a government-run universal health care system?

The alternative, of course, if to refuse to treat people who can’t pay. So if you’re a conservative, is that cool? Are you alright with, say, poor people or illegal immigrants being refused treatment and bleeding to death in front of hospitals? I mean, that’s certainly one approach you could take. Anyone want to step up and own that?

So I don’t see a third way. Either (1) the rest of us who dutifully pay eat the expense for the deadbeats who choose not to pay, or (2) we refuse to treat people who can’t pay for it. The first one seems totally anti-conservative, because it encourages people to leech of others. I mean, if someone else is always going to pay, why should I spend the money upfront? And the second one seems, well, maybe a little cold.

Am I missing a third way? Serious question.


generic said...


What do rich people think when they get stuck in emergency rooms?


Unknown said...

And, if you have health insurance/care and you like it, you can keep it. The government doesn't want to force everyone into the Universal plan. Seems like a no-brainer to me, but then again, I have a brain.

Dan said...

Well, I imagine a conservative would take on your statement, "And if it would be demonstrably cheaper, for society as a whole, to have some kind of low-cost universal health care, why wouldn’t you want that?" I mean, I'm with you 100%, but I doubt that its in fact cheaper to have low-cost universal health care than it is to bail out the occasional deadbeat. Am I missing something?

DrFeelgood said...

You sound like a lawyer or maybe a judge. You've presented two sides assuming they carry equal weight. Your left brain knows what is resonsible to the financial reality and your right brain is pulling at your heart. But you don't want to solve the problem because you think others will judge you. Here is the third way. Ask what burdensome processes, procedures, and litigations drove up the costs of care in the first place and find ways to reverse and dismantle them. Then, the insurance problem might take care of itself.

Anonymous said...

"I will apply, for the benefit of the sick, all measures [that] are required..." - hippocratic oath.

Not like oaths are the most practical of things but the idea of saying 'sorry I can't help you because you can't pay a bill' is something doctors are supposed to reject...

Tamagosan said...

I've often wondered this very same thing. I, like Melissa, have been infected with this brain possession she speaks of.

As for Dr. Feelgood's proposal, I'd say he's on to something. I personally feel that the root of evil here is the fact that the system must be designed to make money as an incentive, and where that occurs, certain people want to make more or protect the money they already have. In my opinion, capitalism has no place in people's health.

Speaking of cost, Germany (where I worked for a year and a half) approaches more of the US system with more private providers, but since my only involvement was my broken foot while there, I'm not too versed in the whole system. The quality of the care was EXTREMELY thorough and good, and really blew me away. Costs were reasonable, even though I was paying out of pocket: The ER visit + FIVE follow-up visits with some more x-rays + daily shots to prevent thrombosis for 5 weeks + crutches + two different kinds of casts and a splint thing came out to under $800. That's RETAIL (as I was filing a claim with my private insurance back home). Cost of hearing a German doctor point to the X-ray of your foot and say, "KAPUT!" = priceless.

In my 5 years in France, I saw how not worrying about paying for health care relieved people's concerns elsewhere in their lives: they weren't forced to stay at jobs they didn't like, they sought medical attention for chronic-but-dealable stuff that would eventually develop into serious ER stuff, etc. I never heard anyone complain about health care ever. I'm not pulling the France card as an ultimate solution (except in cheese and wine, when it is the ultimate solution), but since the main complaints (huge deficit and bureaucracy) already exist here, I'm putting it out there.

A few years ago, my brother, his girlfriend and I held a benefit party for their friend who had lymphoma and the extra-fun $100k+ bills to go along with the disease. The party was awesome (thanks again Speakeasy Brewery for donating so much beer!) and we made lots of money for her, but the whole time I was thinking, really? You need hundreds of people to pay for one person's health bills. And by that I mean about 2-3% of what she owed.

The This American Life segment about a year ago on the history of health care in America (like, why the hell is it related to work at all?? why is your boss responsible for making you healthy?) was pretty cool all around.

@Dan: If I weren't so lazy (ok and late to work, which might let me off the lazy hook), I'd look up the figures of per capital health care spending. I seem to remember Lady Liberty being very high on that list.

Good question TK; I'm sure our great-grandkids will be asking the same. America, Fuck Yeah!

Anonymous said...

As a Canadian-San Franciscan, I find the US health care system baffling even after 10 years. It reminds me of those counties that demand that individuals subscribe to the fire department, and they stand by and let your house burn down if you haven't paid your fee that year.

Anyway, here's a table and data.

And don't get me started on trying to decipher the bills and statements -- you need a degree in rocket surgery to figure them out.

The history of single-payer health care in Canada is an interesting one. It started in one town, then one province, and then went national.

Note that the guy responsible for it, Tommy Douglas, was recently declared the Greatest Canadian.

And note that until this recent recession, the Canadian Government had been running a surplus for 10 years.

Civic Center said...

The U.S. health insurance companies are a branch of organized crime, and there is no way they are going to give up their protection racket until they are literally forced to do so. Since most politicians on both side of the aisle are also in their pockets through donations, I don't see this grotesque situation changing soon. And Tamagosan gets to the heart of it: capitalism and health care are not good bedfellows.

amy.leblanc said...

i agree that the idea of "forcing" people to buy insurance irks me, so i'm with the conservatives on that.

but the problem with this whole revision is that high cost isn't because of deadbeats, like the insurance companies claim they are, it is because of administrative overhead and pharmie reps and all kinds of other bullshit overhead. what needs to be revised is the way healthcare is run from the inside and who is making the money off it. IT SHOULDN'T BE AN EXTREMELY FOR-PROFIT BUSINESS.

in the end, i agree with this:

Anonymous said...

burritojustice: Have you read Atul Gawande's history of how other countries came to have universal health care? It's what I thought of when you mentioned the evolution of Canada's system, which I think he talks about. It's a great piece, not the least of which for simply arguing that universal health care is actually a *sensible* and *practical* solution, not a "bleeding heart liberal" solution. *sigh* I love Gawande.

Anyway, awesome discussion all around.

Oh--and Tamagosan: My friend got a blood clot on a trip to Europe and had to go to the hospital in Germany. The surgery to remove said clot, overnight stay in the hospital, follow-up injection anti-clotting drugs and a pre-flight-home check-up totaled $2,000. And she felt she got better care than if she had gone to the hospital where she lives (near L.A.). Your story totally reminded me of that.

If people can get rid of the dictator who's ruled their country for 30+ years, why can't we ensure that universal health care becomes a reality in our lifetime?